Complaint

Please fill out the form below and submit it to our department for review. You can also download the form as a word doc or PDF, fill it out and submit it to:

NAACP
PO Box 782
Seaside, CA 93955

For questions please call (831) 394-3727

Date of Report: (required)

Please check the type of complaint that you are making: (required)
Retaliation Discrimination Harassment  Housing  Civil Rights Violation/Hate Crime 

Please select the agency, orgnization and/or person of which you are filling the complant against:

Place of Business:
Employer

Date(s) incident occurred: (required)

Please provide the following information about yourself

Your Name: (required)

Your Address: (required)

Your Phone: (required)

Your Email (required)

Your Work Location (required)

Do you currently have an attorney working on your behalf? (required)
Yes No Not Sure 

Attorney’s Name

Attorney’s Address

City, State, ZIP

Attorney’s Telephone Number

Has a lawsuit been filed?
Yes No Not Sure 

If yes, when filed?

Case #

Right to sue letter?
Yes No Not Sure 

Have you filed an EEOC complaint?
Yes No Not Sure 

If yes, when filed?

Case #

Right to sue letter?
Yes No Not Sure 

Have you filed a Fair Employment & Housing complaint?
Yes No Not Sure 

If yes, when filed?

Case #

Right to sue letter?
Yes No Not Sure 

Please include copies of filed complaints and right to sue letters upon submitting this completed form.

Please complete the following about your employer and/or complainant:

Employer (or former employer)

Name: (required)

Address: (required)

Telephone Number: (required)

Supervisor’s Name: (required)

Business Agent/Steward:

District: (required)

Field Base Office 

Time: (required)

Before During After Shift 

Local Union’s Name:

Local Union’s Address:

City, State, ZIP:

Local Union’s Telephone Number:

Has a grievance or complaint been filed?
Yes No Not Sure 

If yes, what is the status of that grievance or complaint?
Closed In Progress Not Sure 

Comments:

Description of incident: (required)

I,(required) do hereby authorize the NAACP Legal Redress Committee to investigate my complaint and to take any steps necessary to resolve it, and I understand that the NAACP is not a legal entity and that the organization has certain limitations as to the scope of their influence and ability.

Signature: (required)

Date: (required)

Witness: (required)

Date: (required)

Copyright ©2011 Monterey NAACP. All Rights Reserved. | Website by:Schipper Design+